我国丙型肝炎治疗现状与相关医疗保障补偿机制分析及建议(1)
中圖分类号 R978.7 文献标志码 A 文章编号 1001-0408(2018)02-0151-05
DOI 10.6039/j.issn.1001-0408.2018.02.02
摘 要 目的：为减轻我国丙型肝炎(简称“丙肝”)疾病负担、完善丙肝治疗的医疗补偿机制及提高丙肝治疗药物的可及性提供依据和建议。方法：通过查阅文献和其他相关资料，分析我国丙肝疫情的流行情况、疾病筛查与诊断情况、治疗进展、疾病经济负担、医保补偿情况以及提高丙肝治疗药物可及性的国际经验。结果：我国1～59岁人群丙型肝炎病毒抗体(抗-HCV)流行率为0.43%，患者以基因1b型为主(占58%)，近38.9%的患者未接受治疗。对于基因1b型患者，聚乙二醇干扰素联用利巴韦林传统疗法的持续病毒学应答率为62%；直接抗病毒药物(DAA)新疗法的治疗效果则明显提升，能使患者获得1.29个质量调整生命年及0.85个生命年。传统疗法和新疗法的单个疗程价格分别为54 960、57 810元，但新疗法由于可规避终末期肝病，从而可为每位患者节省378元的疾病管理成本。职工和居民医保丙肝住院患者采用传统疗法，经医保补偿后自付成本大幅下降；而新疗法2017年才在我国获批，尚未被医保覆盖。结论：新疗法较之传统疗法，具有成本-效果优势。我国需加强对丙肝患者的关注，采取措施减轻其疾病经济负担，通过完善丙肝治疗的基本医疗保险与专项医疗救助资金等多种补偿措施，提高丙肝新治疗方案药物的可及性。
关键词 丙型肝炎；疾病负担；医疗保障补偿
ABSTRACT OBJECTIVE： To provide reference and suggestion for relieving the disease burden of hepatitis C (HC) in China， improving medical compensation mechanism of HC treatment and the accessibility of HC drugs. METHODS： By reviewing literatures and other relevant information， the epidemic situation of HC， the situation of disease screening and diagnosis， treatment progress， the economic burden of disease， medical insurance compensation in China and international experience on improving the accessibility of HC drugs were all analyzed. RESULTS： The anti-HCV prevalence rate of 1 to 59-year-old population was 0.43% in China， and the genotype was mainly genotype 1b(58%). Nearly 38.9% of the patients were not treated. For patients with genotype 1b， the sustained virologic response rate of traditional PEG-interferon combined with ribavirin regimen was 62%， and the effect of new direct-acting antivirals (DAA) regimen was improved significantly； patients receiving new regimen could gain 1.29 QALYs and 0.85 life years. The costs of a single course for traditional and new regimens were 54 960 yuan and 57 810 yuan， respectively. New regimen could save 378 yuan for the cost of disease management for each patient due to evasion of end-stage liver disease. After medical insurance compensation， the cost of self payment had fallen sharply for workers and residents receiving traditional regimen， while new regimen was approved in China in 2017 and had not been covered by medical insurance yet. CONCLUSIONS： New regimen has a cost-effectiveness advantage over traditional regimen. The state should pay more attention to HC patients and take measures to reduce the economic burden of them. By improving the basic medical insurance and special medical assistance fund for HC treatment， the accessibility of the drugs in new HC treatment regimen can be improved., http://www.100md.com(常峰 段承阿鑫 金琇泽 司徒冰 路云)
DOI 10.6039/j.issn.1001-0408.2018.02.02
摘 要 目的：为减轻我国丙型肝炎(简称“丙肝”)疾病负担、完善丙肝治疗的医疗补偿机制及提高丙肝治疗药物的可及性提供依据和建议。方法：通过查阅文献和其他相关资料，分析我国丙肝疫情的流行情况、疾病筛查与诊断情况、治疗进展、疾病经济负担、医保补偿情况以及提高丙肝治疗药物可及性的国际经验。结果：我国1～59岁人群丙型肝炎病毒抗体(抗-HCV)流行率为0.43%，患者以基因1b型为主(占58%)，近38.9%的患者未接受治疗。对于基因1b型患者，聚乙二醇干扰素联用利巴韦林传统疗法的持续病毒学应答率为62%；直接抗病毒药物(DAA)新疗法的治疗效果则明显提升，能使患者获得1.29个质量调整生命年及0.85个生命年。传统疗法和新疗法的单个疗程价格分别为54 960、57 810元，但新疗法由于可规避终末期肝病，从而可为每位患者节省378元的疾病管理成本。职工和居民医保丙肝住院患者采用传统疗法，经医保补偿后自付成本大幅下降；而新疗法2017年才在我国获批，尚未被医保覆盖。结论：新疗法较之传统疗法，具有成本-效果优势。我国需加强对丙肝患者的关注，采取措施减轻其疾病经济负担，通过完善丙肝治疗的基本医疗保险与专项医疗救助资金等多种补偿措施，提高丙肝新治疗方案药物的可及性。
关键词 丙型肝炎；疾病负担；医疗保障补偿
ABSTRACT OBJECTIVE： To provide reference and suggestion for relieving the disease burden of hepatitis C (HC) in China， improving medical compensation mechanism of HC treatment and the accessibility of HC drugs. METHODS： By reviewing literatures and other relevant information， the epidemic situation of HC， the situation of disease screening and diagnosis， treatment progress， the economic burden of disease， medical insurance compensation in China and international experience on improving the accessibility of HC drugs were all analyzed. RESULTS： The anti-HCV prevalence rate of 1 to 59-year-old population was 0.43% in China， and the genotype was mainly genotype 1b(58%). Nearly 38.9% of the patients were not treated. For patients with genotype 1b， the sustained virologic response rate of traditional PEG-interferon combined with ribavirin regimen was 62%， and the effect of new direct-acting antivirals (DAA) regimen was improved significantly； patients receiving new regimen could gain 1.29 QALYs and 0.85 life years. The costs of a single course for traditional and new regimens were 54 960 yuan and 57 810 yuan， respectively. New regimen could save 378 yuan for the cost of disease management for each patient due to evasion of end-stage liver disease. After medical insurance compensation， the cost of self payment had fallen sharply for workers and residents receiving traditional regimen， while new regimen was approved in China in 2017 and had not been covered by medical insurance yet. CONCLUSIONS： New regimen has a cost-effectiveness advantage over traditional regimen. The state should pay more attention to HC patients and take measures to reduce the economic burden of them. By improving the basic medical insurance and special medical assistance fund for HC treatment， the accessibility of the drugs in new HC treatment regimen can be improved., http://www.100md.com(常峰 段承阿鑫 金琇泽 司徒冰 路云)